U.S. patent application number 12/486162 was filed with the patent office on 2010-12-23 for adapter for electrostimulation lead and method for reducing extracardiac stimulation.
Invention is credited to James J. Ong.
Application Number | 20100324617 12/486162 |
Document ID | / |
Family ID | 43354962 |
Filed Date | 2010-12-23 |
United States Patent
Application |
20100324617 |
Kind Code |
A1 |
Ong; James J. |
December 23, 2010 |
ADAPTER FOR ELECTROSTIMULATION LEAD AND METHOD FOR REDUCING
EXTRACARDIAC STIMULATION
Abstract
A method of cardiac electrostimulation of a patient with a
cardiac electrostimulation device includes implanting a first
electrode in the left ventricle of the patient. A second electrode
is implanted in the heart of the patient. In some embodiments, the
first electrode and second electrode are electrically connected in
parallel and share a common anode. The method reduces the
likelihood of phrenic stimulation in the patient. Adapters and
electrostimulation devices are also disclosed.
Inventors: |
Ong; James J.; (Woodland
Hills, CA) |
Correspondence
Address: |
ITALIA IP
3500 WEST OLIVE AVE., SUITE 300
BURBANK
CA
91505
US
|
Family ID: |
43354962 |
Appl. No.: |
12/486162 |
Filed: |
June 17, 2009 |
Current U.S.
Class: |
607/9 ;
439/502 |
Current CPC
Class: |
H01R 31/02 20130101;
H01R 2201/12 20130101; A61N 1/3601 20130101; A61N 1/056 20130101;
A61N 1/362 20130101; H01R 31/06 20130101; A61N 1/3752 20130101 |
Class at
Publication: |
607/9 ;
439/502 |
International
Class: |
A61N 1/362 20060101
A61N001/362; H01R 11/00 20060101 H01R011/00 |
Claims
1. An adapter for coupling two or more electrodes to an
electrostimulation device, the adapter comprising: a yoke portion;
a connector portion extending distally from the yoke portion, the
connector portion including a lead connector having a ring and a
tip, wherein the connector portion is configured for reception by
an electrostimulation device; a first receptacle configured to
accept an electrode and connected to the yoke portion, the first
receptacle including a ring and a tip, wherein the ring is in
electrical communication with the connector portion ring, and
wherein the tip is in electrical communication with the connector
portion tip; and a second receptacle configured to accept an
electrode and connected to the yoke portion, the second receptacle
having a ring and a tip, wherein one of the tip and the ring is in
electrical communication with the connector portion tip, and
wherein the other of the tip and the ring is electrically
isolated.
2. The adapter of claim 1 wherein the second receptacle ring is in
electrical communication with the connector portion tip.
3. The adapter of claim 2 wherein the second receptacle tip is
electrically isolated from the connector portion tip and the
connector portion ring.
4. The adapter of claim 2 wherein the second receptacle ring is
electrically parallel with the first receptacle tip.
5. The adapter of claim 1 wherein the second receptacle tip is in
electrical communication with the connector portion tip.
6. The adapter of claim 5 wherein the second receptacle ring is
electrically isolated from the connector portion ring and connector
portion tip.
7. The adapter of claim 5 wherein the second receptacle tip is
electrically parallel with the first receptacle tip.
8. The adapter of claim 1 further comprising an adjustable resistor
in electrical communication with the connector portion and the
first receptacle, the adjustable resistor operable to selectively
adjust the current density to a lead in electrical communication
with the first receptacle.
9. The adapter of claim 1 further comprising an adjustable resistor
in electrical communication with the connector portion and the
second receptacle, the adjustable resistor operable to selectively
adjust the current density to a lead in electrical communication
with the second receptacle.
10. The adapter of claim 1 further comprising a first electrode for
implantation within a patient, the first electrode in electrical
communication with the first receptacle; and a second electrode for
implantation within a left ventricle of a patient, the second
electrode in electrical communication with the second
receptacle.
11. A method of cardiac electrostimulation of a patient with a
cardiac electrostimulation device, the method comprising:
implanting a first electrode in the patient; and implanting a
second electrode in the left ventricle of the patient, wherein the
first electrode and second electrode are electrically connected in
parallel, and wherein the first electrode and second electrode
share a common anode.
12. The method of claim 11 wherein the second electrode comprises a
tip, and wherein the first electrode comprises a ring and a tip,
wherein the second electrode tip and first electrode tip are
electrically connected in parallel.
13. The method of claim 11 wherein the second electrode comprises a
ring, and wherein the first electrode comprises a ring and a tip,
wherein the second electrode ring and first electrode tip are
electrically connected in parallel.
14. The method of claim 11 wherein the first electrode is implanted
in one of the patient's right ventricle, left ventricle, superior
vena cava, a cardiac vein, coronary sinus, or the great cardiac
vein.
15. The method of claim 11 further comprising implanting an
electrode in the right ventricle of the patient.
16. The method of claim 15 further comprising implanting an
electrode in the right atrium of the patient.
17. A cardiac electrostimulation device comprising: a cardiac
electrostimulator; a first receptacle for receiving a first
electrode, the first receptacle in electrical communication with
the electrostimulator, the first receptacle including a ring
portion and a tip portion; a second receptacle for receiving a
second electrode, the second receptacle in electrical communication
with the electrostimulator, the second receptacle including a ring
portion and a tip portion; a third receptacle for receiving a third
electrode for implantation within the left ventricle of a patient,
the third receptacle in electrical communication with the
electrostimulator, the third receptacle including a tip portion;
and a fourth receptacle for receiving a fourth electrode, the
fourth receptacle in electrical communication with the
electrostimulator, the fourth receptacle including a ring portion
and a tip portion.
18. The device of claim 17 wherein the third receptacle tip portion
is electrically connected in parallel with the fourth receptacle
tip portion, and wherein the fourth receptacle ring portion serves
as a common anode for the third and fourth receptacles.
19. A cardiac electrostimulation device comprising: a cardiac
electrostimulator; a first receptacle for receiving a first
electrode, the first receptacle in electrical communication with
the electrostimulator, the first receptacle including a ring
portion and a tip portion; a second receptacle for receiving a
second electrode, the second receptacle in electrical communication
with the electrostimulator, the second receptacle including a ring
portion and a tip portion; a third receptacle for receiving a third
electrode for implantation within the left ventricle of a patient,
the third receptacle in electrical communication with the
electrostimulator, the third receptacle including a ring portion;
and a fourth receptacle for receiving a fourth electrode, the
fourth receptacle in electrical communication with the
electrostimulator, the fourth receptacle including a ring portion
and a tip portion.
20. The device of claim 19 wherein the third receptacle ring
portion is electrically connected in parallel with the fourth
receptacle tip portion, and wherein the fourth receptacle ring
portion serves as a common anode for the third and fourth
receptacles.
21. An adapter for coupling an electrode to an electrostimulation
device, the adapter comprising: a connector portion having a
unipolar lead with a tip, wherein the connector portion is
configured for reception by an electrical stimulation device; and a
receptacle configured to accept an electrode and connected to the
connector portion, the receptacle having a ring and a tip, wherein
the ring is in electrical communication with the connector portion
tip, and wherein the receptacle tip is in electrical isolation.
22. The adapter of claim 21 further comprising an electrode for
implantation within a left ventricle of a patient, the electrode in
electrical communication with the receptacle.
23. An adapter for coupling an electrode to an electrostimulation
device, the adapter comprising: a connector portion including a
lead connector having a ring and a tip, wherein the connector
portion is configured for reception by an electrostimulation
device, wherein the ring is configured for electrical communication
with an anode of the electrostimulation device, and wherein the tip
is configured for electrical communication with a cathode of the
electrostimulation device; and a receptacle configured to accept an
electrode and in electrical communication with the connector
portion, the receptacle including a ring and a tip, wherein the
ring is in electrical communication with the connector portion tip,
and wherein the tip is in electrical communication with the
connector portion ring.
Description
BACKGROUND OF INVENTION
[0001] This application relates to the field of pacemakers (PM) and
implantable defibrillators (ICD) and in particular devices and
methods of delivering Cardiac Resynchronization Therapy (CRT) in
patients who may experience intractable phrenic nerve stimulation
during CRT.
SUMMARY
[0002] Permanent cardiac electrostimulation, such as permanent PMs
and ICDS, are bioelectrical devices designed to monitor and
maintain heart rates of patients with either too slow of a heart
rate or too fast of a heart rate. These devices are comprised of
two basic components, namely a pulse generator contained within a
casing, which is subcutaneously implanted, and leads which extend
from the pulse generator through the veins and into the heart
chamber. The leads function as the pathway for the
electrostimulation device to deliver electrical impulses to the
heart muscle in order to maintain a normal heart rate.
[0003] The leads are generally defined as either unipolar or
bipolar. A unipolar lead is a lead having one electrode, the
cathode, at its distal tip. To complete the electrical circuit, the
other electrode, the anode, is at the pulse generator located on
the chest. Bipolar leads, on the other hand, have both the cathode
and anode at or near the end of the lead within the heart chamber.
The distal electrode of the pair is the cathode, the proximal the
anode.
[0004] Typical electrostimulation systems consist of two leads, one
in the Right Atrium (RA) and one in the Right Ventricle (RV). This
is referred to as a "dual chamber" PM or ICD. It maintains
synchrony between the atrium and the ventricle. However, synchrony
between the right and left ventricle is not maintained, and, in
fact, is frequently disturbed, when pacing occurs through the right
ventricle only. Creation of such dysynchronization between the
ventricles frequently leads to heart failure.
[0005] CRT is a method of delivering pacing in both the right and
left ventricles, and thus is commonly referred to as "biventricular
pacing." CRT may be particularly useful in patients with failing
hearts, in which the electrical and mechanical function have lost
the usual "synchrony" that is seen in healthy heart. Restoration of
this synchrony is the goal in CRT.
[0006] CRT is achieved by, in addition to the standard RA and RV
leads in a dual chamber PM or ICD, implanting an additional
electrode in the left ventricle (LV) either epicardially via a
thoracotomy or transvenously via the coronary sinus venous system.
Resynchronization is thus achieved by pacing, simultaneously, or
with a preset small time difference, both the RV and LV.
[0007] One limitation to the successful implantation of an LV lead,
and thus, the successful delivery of CRT, is the presence of
phrenic nerve stimulation. The phrenic nerve is a nerve that
controls the movement of the diaphragm and is responsible for
important activities such as breathing, as well as annoyances such
as hiccups. The nerve runs along side of the heart and is often in
close proximity to where the LV lead is implanted. As a result,
stimulating the heart through the LV lead can lead to intractable
hiccuping if the lead is too close to the phrenic nerve.
[0008] As previously mentioned, the LV lead may be implanted
transvenously through the coronary sinus venous system. Since the
venous anatomy for each patient is generally fixed, a surgeon
usually does not have many options where to implant the LV lead.
Even if there is more than one vein, other veins are also
frequently associated with phrenic nerve stimulation. Successful
insertion is also limited by the size and contour of the vein.
Additionally, not all veins are suitable for LV pacing. Even with
epicardial implantation of an LV electrode, phrenic nerve
stimulation may be inevitable. Thus, in the case of phrenic nerve
stimulation, it frequently means CRT failure. This application
discloses devices and methods for reducing the amount of and/or
instances of phrenic nerve stimulation whilst delivering CRT.
[0009] In particular, this application discloses an adapter for
coupling two or more electrodes to an electrostimulation device,
the adapter comprising: a yoke portion; a connector portion
extending distally from the yoke portion, the connector portion
including a bipolar lead connector having a ring and a tip, wherein
the connector portion is configured for reception by an
electrostimulation device; a first receptacle configured to accept
an electrode and connected to the yoke portion, the first
receptacle including a ring and a tip, wherein the ring is in
electrical communication with the connector portion ring, and
wherein the tip is in electrical communication with the connector
portion tip; and a second receptacle configured to accept an
electrode and connected to the yoke portion, the second receptacle
having a ring and a tip, wherein one of the tip and the ring is in
electrical communication with the connector portion tip, and
wherein the other of the tip and the ring is electrically
isolated.
[0010] This application further discloses a method of cardiac
electrostimulation of a patient with a cardiac electrostimulation
device, the method comprising: implanting a first electrode in the
patient; and implanting a second electrode in the left ventricle of
the patient, wherein the first electrode and second electrode are
electrically connected in parallel, and wherein the first electrode
and second electrode share a common anode.
[0011] This application also discloses a cardiac electrostimulation
device comprising: a cardiac electrostimulator; a first receptacle
for receiving a first electrode, the first receptacle in electrical
communication with the electrostimulator, the first receptacle
including a ring portion and a tip portion; a second receptacle for
receiving a second electrode, the second receptacle in electrical
communication with the electrostimulator, the second receptacle
including a ring portion and a tip portion; a third receptacle for
receiving a third electrode for implantation within the left
ventricle of a patient, the third receptacle in electrical
communication with the electrostimulator, the third receptacle
including a tip portion; and a fourth receptacle for receiving a
fourth electrode, the fourth receptacle in electrical communication
with the electrostimulator, the fourth receptacle including a ring
portion and a tip portion.
[0012] This application further discloses a cardiac
electrostimulation device comprising: a cardiac electrostimulator;
a first receptacle for receiving a first electrode, the first
receptacle in electrical communication with the electrostimulator,
the first receptacle including a ring portion and a tip portion; a
second receptacle for receiving a second electrode, the second
receptacle in electrical communication with the electrostimulator,
the second receptacle including a ring portion and a tip portion; a
third receptacle for receiving a third electrode for implantation
within the left ventricle of a patient, the third receptacle in
electrical communication with the electrostimulator, the third
receptacle including a ring portion; and a fourth receptacle for
receiving a fourth electrode, the fourth receptacle in electrical
communication with the electrostimulator, the fourth receptacle
including a ring portion and a tip portion.
[0013] This application also discloses an adapter for coupling an
electrode to an electrostimulation device, the adapter comprising:
a connector portion having a unipolar lead with a tip, wherein the
connector portion is configured for reception by an electrical
stimulation device; and a receptacle configured to accept an
electrode and connected to the connector portion, the receptacle
having a ring and a tip, wherein the ring is in electrical
communication with the connector portion tip, and wherein the
receptacle tip is in electrical isolation.
[0014] Moreover, this application discloses an adapter for coupling
an electrode to an electrostimulation device, the adapter
comprising: a connector portion including a bipolar lead connector
having a ring and a tip, wherein the connector portion is
configured for reception by an electrostimulation device, wherein
the ring is configured for electrical communication with an anode
of the electrostimulation device, and wherein the tip is configured
for electrical communication with a cathode of the
electrostimulation device; and a receptacle configured to accept an
electrode and in electrical communication with the connector
portion, the receptacle including a ring and a tip, wherein the
ring is in electrical communication with the connector portion tip,
and wherein the tip is in electrical communication with the
connector portion ring.
BRIEF DESCRIPTION OF THE DRAWINGS
[0015] The drawings, when considered in connection with the
following description, are presented for the purpose of
facilitating an understanding of the subject matter sought to be
protected.
[0016] FIG. 1 is a plan view of an adapter for coupling two or more
electrodes to an electrostimulation device;
[0017] FIG. 2A is a schematic view of a receptacle of FIG. 1;
[0018] FIG. 2B is a schematic view of an alternative receptacle of
FIG. 1;
[0019] FIG. 3A is a schematic view of an electrostimulation
device;
[0020] FIG. 3B is a schematic view of an alternative
electrostimulation device;
[0021] FIG. 4A is a plan view of an adapter for coupling an
electrode to an electrostimulation device;
[0022] FIG. 4B is a schematic view of a receptacle of FIG. 3A;
and
[0023] FIG. 5 is a schematic view of an adapter for coupling an
electrode to an electrostimulation device.
DETAILED DESCRIPTION
[0024] Referring now to FIG. 1, an illustrative adapter 100 for
electrically coupling two or more electrodes to an
electrostimulation device, such as a pacemaker or implantable
defibrillator, is shown. The adapter 100 generally includes a yoke
portion 102, a connector portion 104, a first receptacle 106 and a
second receptacle 108. The yoke portion 102 provides electrical
communication between the connector portion 104 and the first and
second receptacles 106, 108. The connector portion 104 includes a
bipolar lead connector 114 having a ring 110 and a tip 112. The
bipolar lead connector 114 may be any suitable bipolar, or
multipolar, lead connector, including, but not limited to, IS1,
IS4, LV1, 6 mm, or any other suitable bipolar, or multipolar, lead
connector. The connector portion 104 extends distally from the yoke
portion 102 and is configured to be received by a receptacle of a
electrostimulation device whereby electrical signals are
transmitted from the electrostimulation device to the connector
portion 104, wherein the ring 110 electrically communicates with
the anode portion of the electrostimulation device and wherein the
tip 112 electrically communicates with the cathode portion of the
electrostimulation device
[0025] The first receptacle 106 is configured to accept a bipolar,
or multipolar, electrode that provides electrical stimulation to
the target tissue, including, but not limited to, heart tissue.
Illustrative electrodes include, without limitation, IS1, IS4, LV1,
6 mm, etc. The first receptacle 106 includes a ring 116 and a tip
118. A lumen 120 extends between the first receptacle 106 and yoke
portion 102. The lumen 120 provides electrical communication
between the first receptacle 106 and the yoke portion 102. The
lumen 120 includes an electrically conductive core (not shown) that
provides, via the yoke, electrical communication between the tip
118 and the connector portion tip 112. Additionally, the lumen 120
includes an electrically conductive outer coil (not shown) that
provides, via the yoke, electrical communication between the ring
116 and the connector portion ring 110. The core and outer coil of
the lumen 120 are insulated from one another. The tip 118 is
operative to receive a corresponding tip of an electrode and the
ring 116 is operative to receive a corresponding ring of an
electrode. Thus, the electrode tip may be in electrical
communication with the connector portion tip 112, such that the
electrode tip may be in electrical communication with the
electrostimulation device cathode, and the electrode ring may be in
electrical communication with the connector portion ring 110, such
that the electrode ring may be in electrical communication with the
electrostimulation device anode. An electrode coupled to the first
receptacle 106 may be implanted in the right ventricle (RV), left
ventricle (LV), superior vena cava (SVC), a second cardiac vein,
coronary sinus (CS), or the great cardiac vein. It will, however,
be appreciated that an electrode extending from the receptacle 106
may be a "fourth electrode" and may be implanted in any suitable
location and such suitable locations are not limited to the
forgoing examples. The term "fourth electrode" will be appreciated
to convey that an electrode extending from the receptacle 106 (i.e.
the "fourth electrode") may be used in conjunction with a left
ventricle electrode (as will be described below) as well as
conventional right atrium and right ventricle electrodes.
Nevertheless, it will be appreciated that the term "fourth
electrode" is illustrative only and not limiting in any way and in
no way limits the present disclosure to embodiments employing just
four electrodes. For example, an electrode extending from the first
receptacle 106 may be used in conjunction with a left ventricle
electrode (as will be described below) and a conventional right
ventricle electrode. Alternatively, any suitable number of
conventional electrodes may be employed with an electrode extending
from the first receptacle 106 and a left ventricle electrode (as
will be described below).
[0026] The second receptacle 108 may be configured to accept either
a bipolar, multipolar, or unipolar electrode for providing
electrical stimulation to the target tissue, such as heart tissue.
Suitable electrodes, include, without limitation, IS1, IS4, LV1,
DF1, 6 mm, etc. The second receptacle 108 may include a ring 124,
configured to receive an electrode ring, and a tip 122, configured
to receive an electrode tip. A lumen 126 provides electrical
communication between the second receptacle 108 and the yoke
portion 102.
[0027] Either the tip 122 or ring 124 is in electrical
communication with the connector portion tip 112 and the other one
of the pair (i.e., the tip 122 or ring 124) is electrically
isolated. In some embodiments, the tip 122 or ring 124 that is in
electrical communication with the connector portion tip 112 is also
electrically connected in parallel with the first receptacle tip
118. Additionally, in one embodiment, the first receptacle ring 116
acts as a common anode for an an electrode in communication with
the first receptacle 106 and an electrode in communication with the
second receptacle 108. Advantageously, by coupling the LV electrode
to the second receptacle 108, extra cardiac stimulation, such as
phrenic nerve stimulation, may be diminished or eliminated.
[0028] In one embodiment, the tip 122 is in electrical
communication with the connector portion tip 112 and the ring 124
is electrically isolated. In the illustrative embodiment of FIG.
2A, the lumen 126 does not include a conductive outer coil and the
core 130 of the lumen 126 provides electrical communication between
the tip 122 and the connector portion tip 112 via the yoke 102. In
an alternative embodiment, the conductive outer coil of the lumen
126 is terminated in the second receptacle 108 such that the
conductive outer coil and ring 124 are not in electrical
communication. Electrical communication between the tip 122 and the
connector portion tip 112 is provided by the conductive core 130 of
the lumen 126 and the yoke 102. It will be appreciated that the tip
122 and connector portion tip 112 may be electrically connected by
any suitable means and the present disclosure is in no way limited
to the illustrative schematic.
[0029] Additionally, in one embodiment, the second receptacle tip
122 and first receptacle tip 118 are electrically connected in
parallel via the yoke 102. Further, in one embodiment, the first
receptacle ring 116 acts as a common anode for an electrode
extending from the second receptacle 108 and an electrode extending
from the first receptacle 106. As mentioned, an electrode extending
from the second receptacle 108 is implanted in the LV.
[0030] Referring again to FIG. 1, in another embodiment, the ring
124 is in electrical communication with the connector portion tip
112 and the second receptacle tip 122 is electrically isolated. In
one embodiment, as shown in FIG. 2B, the lumen 126 does not include
a conductive core and an outer coil. Rather, the lumen 126 includes
a conductive wire 135, which provides electrical communication
between the ring 124 and the connector portion tip 112 via the yoke
102. In an alternative embodiment, the conductive outer coil of the
lumen 126 is terminated in the second receptacle 108 such that the
conductive outer coil and ring 124 are not in electrical
communication. Electrical communication between the ring 124 and
the connector portion tip 112 is provided by the conductive core of
the lumen 126 and via the yoke 102. It will be appreciated that the
ring 124 and connector portion tip 112 may be electrically
connected by any suitable means and the present disclosure is in no
way limited to the illustrative schematic.
[0031] Additionally, in one embodiment, the second receptacle ring
124 and first receptacle tip 118 are electrically connected in
parallel via the yoke 102, whereby the second receptacle ring 124
and first receptacle tip 118 are in electrical communication with a
cathode of the electrostimulation device. Further, in one
embodiment, the first receptacle ring 116 acts as a common anode
for an electrode extending from the second receptacle 108 and an
electrode extending from the first receptacle 106. As mentioned, an
electrode extending from the second receptacle 108 is implanted in
the LV.
[0032] Optionally, one or more adjustable resistors (not shown) may
be in electrical communication with the connector portion and one
or both of the receptacles 106, 108. Advantageously, the resistance
may be adjusted by an operator implanting leads extending from the
receptacle(s). By adjusting the resistance via the adjustable
resistors, the current density at each lead may be adjusted such
that extra cardiac stimulation may be minimized. Also, it will be
appreciated that adjustable resistors for controlling current
densities for various electrodes may be employed with any suitable
connector for coupling one or more electrodes to an
electrostimulation device and the use of adjustable resistors for
the purpose of controlling current densities of one or more
electrodes is not limited to the forgoing connectors and the use of
adjustable resistors with any suitable connector is expressly
contemplated by the present disclosure.
[0033] A method for providing cardiac electrostimulation to a
patient whilst reducing, or eliminating, the likelihood of phrenic
nerve stimulation, or other extracardiac stimulation, is also
provided. The method includes implanting a first electrode in, or
near, the heart of a patient. The first electrode may be bipolar or
multipolar. The first electrode may include a ring portion, for
electrical communication with with an anode of an
electrostimulation device, and a tip portion, for electrical
communication with a cathode of an electrostimulation device. The
first electrode may be implanted in any suitable location,
including, but not limited to, the right ventricle (RV), left
ventricle (LV), superior vena cava (SVC), a second cardiac vein,
coronary sinus (CS), or great cardiac vein. A second electrode is
implanted in the left ventricle of the patient. The second
electrode may be unipolar, bipolar or multipolar. The second
electrode may include one or both of a ring portion and a tip
portion. In one embodiment, the tip portion of the first electrode
is electrically connected in parallel with a tip portion of the
second electrode and the ring of the second electrode is
electrically isolated. The ring of the first electrode may serve as
a common anode for the first and second electrodes. In an
alternative embodiment, the tip portion of the first electrode is
electrically connected in parallel with a ring portion of the
second electrode and the tip of the second electrode is
electrically isolated. The ring of the first electrode may serve as
a common anode for the first and second electrodes. The method may
also include implanting an electrode in the right ventricle of the
patient and/or implanting an electrode in the right atrium of the
patient.
[0034] Referring now to FIG. 3A, a cardiac electrostimulation
device 200 is shown. The device 200 includes a cardiac
electrostimulator generally represented by block 202. The
electrostimulator 202 may be an ICD, a PM, or any other suitable
stimulation device. The electrostimulator 202 may include
circuitry, computer(s), one or more batteries, or any other
components for electrically stimulating the heart of a patient.
[0035] The device 200 may also include a first receptacle 204
having a ring portion 206 and a tip portion 208. The first
receptacle 204 is in electrical communication with the
electrostimulator 202, wherein the ring portion 206 is in
electrical communication with an anode of the electrostimulator 202
and wherein the tip portion 208 is in electrical communication with
the cathode of the electrostimulator 202. The first receptacle 204
may be configured to receive a first electrode and provide
electrical communication between the electrostimulator 202 and the
first electrode. Illustrative first electrodes, include, without
limitation, IS1, IS4, LV1, 6 mm, etc. An electrode in electrical
communication with the first receptacle 204 may be implanted in any
suitable location within the heart of a patient, including, but not
limited to, the right atrium, right ventricle, etc. It will be
appreciated that the first receptacle is optional and a device not
having such a first receptacle is still encompassed by the present
disclosure. Additionally, it will be appreciated that the device
may include any suitable number of receptacles configured as the
illustrative first receptacle 204 and remain within the scope of
the present disclosure.
[0036] The device 200 may also include a second receptacle 222
having a ring portion 224 and a tip portion 226. The second
receptacle 222 is in electrical communication with the
electrostimulator 202, wherein the ring portion 224 is in
electrical communication with an anode of the electrostimulator 202
and wherein the tip portion 226 is in electrical communication with
a cathode of the electrostimulator 202. The second receptacle 222
may be configured to receive a second electrode and provide
electrical communication between the electrostimulator 202 and the
second electrode. Illustrative second electrodes, include, without
limitation, IS1, IS4, LV1, 6 mm, etc. An electrode in electrical
communication with the second receptacle 222 may be implanted in
any suitable location within the heart of a patient, including, but
not limited to, the right atrium, right ventricle, etc. It will be
appreciated that the second receptacle is optional and a device not
having such a second receptacle is still encompassed by the present
disclosure. Additionally, it will be appreciated that the device
may include any suitable number of receptacles configured as the
illustrative second receptacle 222 and remain within the scope of
the present disclosure.
[0037] The device 200 also includes a third receptacle 210 and a
fourth receptacle 212. The third receptacle 210 is in electrical
communication with the electrostimulator 202. The third receptacle
210 includes a tip portion 214 wherein the tip portion 214 is in
electrical communication with a cathode of the electrostimulator
202. The third receptacle 210 is configured to receive a third
electrode for implantation within the left ventricle of a patient
and provide electrical communication between the third electrode
and electrostimulator 202. Illustrative third electrodes, include,
without limitation, IS1, IS4, LV1, 6 mm, etc.
[0038] The fourth receptacle 212 includes a ring portion 216 and a
tip portion 218. The fourth receptacle 212 is in electrical
communication with the electrostimulator 202 wherein the ring
portion 216 is in electrical communication with an anode of the
electrostimulator 202 and wherein the tip portion 218 is in
electrical communication with a cathode of the electrostimulator
202. Additionally, in one embodiment, the tip portion 218 is
electrically connected in parallel with the third receptacle tip
portion 214 such that the ring portion 216 of the fourth receptacle
serves as a common anode for a third electrode coupled to the third
receptacle 210 and a fourth electrode coupled to the fourth
receptacle 212. The fourth receptacle 212 is configured to receive
a fourth electrode for implantation within the heart of the patient
and provide electrical communication between the fourth electrode
and electrostimulator 202. Illustrative fourth electrodes, include,
without limitation, IS1, IS4, LV1, 6 mm, etc. Moreover the fourth
electrode may be implanted in any suitable location within the
heart of the patient, including, but not limited to, the right
ventricle (RV), left ventricle (LV), superior vena cava (SVC), a
second cardiac vein, coronary sinus (CS), or the great cardiac
vein.
[0039] With particular reference to FIG. 3B, an alternative device
200 is shown. The first and second receptacles 204, 222 may be
configured as described with respect to FIG. 3A. The device 200 may
be configured such that the third receptacle 210 includes a ring
portion 220 and no tip portion. The third receptacle ring portion
220 is in electrical communication with a cathode of the
electrostimulator 202. Additionally, in one embodiment, the third
receptacle ring portion 220 may be electrically connected in
parallel with the fourth receptacle tip portion 218. Also, in one
embodiment, the ring portion 216 of the fourth receptacle 212 may
serve as a common anode for respective electrodes in communication
with the third receptacle 210 and fourth receptacle 212. An
electrode in communication with the third receptacle 210 may be
implanted within the left ventricle of a patient and an electrode
in communication with the fourth receptacle 212 may be implanted in
any suitable location within the heart of the patient, including,
but not limited to, the right ventricle (RV), left ventricle (LV),
superior vena cava (SVC), a second cardiac vein, coronary sinus
(CS), or the great cardiac vein.
[0040] Referring now to FIGS. 4A-4B, another adapter 300 for
coupling an electrode to an electrostimulation device is shown. The
adapter 300 includes a connector portion 302 and a receptacle 304.
The connector portion 302 includes a unipolar lead connector 306
and a tip 301 for electrically communicating with a cathode of an
electrostimulation device. The connector portion 302 is configured
to be received by a receptacle of a electrostimulation device
whereby electrical signals are transmitted from the
electrostimulation device to the connector portion 302 and
ultimately through an electrode in electrical communication with
the receptacle 304.
[0041] The receptacle 304 is configured to accept a bipolar, or
multipolar, electrode that provides electrical stimulation to the
target tissue, including, but not limited to, heart tissue.
Illustrative electrodes, include, without limitation, IS1, IS4,
LV1, 6 mm, etc. The receptacle 304 includes a tip 308 and a ring
310. The tip 308 is configured to receive an electrode tip. Also,
the ring 310 is adapted to receive an electrode ring. A lumen 312
extends between the receptacle 304 and the connector portion 302.
The lumen 312 includes an electrically conductive core 314 (see
FIG. 4B) which provides electrical communication between the ring
310 and the connector portion tip 301. Therefore, the receptacle
ring 310 is in electrical communication with a cathode of the
electrostimulation device and the tip 308 is electrically isolated
such that the ring of an electrode in communication with the
receptacle 304 acts as the cathode for the electrode.
Advantageously, the adapter 300 may be used where the tip of the
electrode initially causes phrenic nerve stimulation; wherein, this
adapter 300 reverses the polarity of the electrode thereby
utilizing the electrode ring as the preferred pacing site. This may
be useful when an electrostimulation device does not include
"electronic repositioning" capability.
[0042] Referring now to FIG. 5, another adapter 400 for coupling an
electrode to an electrostimulation device is shown. The adapter 400
includes a connector portion 402 and a receptacle 404. The
connector portion 402 includes a bipolar lead connector 406 having
a ring 414 and a tip 416. The lead connector 406 is configured to
be received by an electrostimulation device such that the ring 414
is in electrical communication with an anode of the
electrostimulation device and the tip 416 is in electrical
communication with a cathode of the electrostimulation device,
whereby electrical signals are transmitted from the
electrostimulation device to the connector portion 402 and
ultimately through an electrode in electrical communication with
the receptacle 404.
[0043] The receptacle 404 is configured to accept a bipolar, or
multipolar, electrode that provides electrical stimulation to the
target tissue, including, but not limited to, heart tissue.
Illustrative electrodes, include, without limitation, IS1, IS4,
LV1, 6 mm, etc. The receptacle 404 includes a tip 408 and a ring
410. The tip 408 is configured to receive an electrode tip and the
ring 410 is configured to receive an electrode ring. A lumen 412
extends between the receptacle 404 and the connector portion 402.
The lumen 412 includes a first electrically conductive portion 420,
such as a wire, which provides electrical communication between the
receptacle ring 410 and the connector portion tip 416, and a second
electrically conductive portion 418, such as a second wire which
may be insulated from the first wire, which provides electrical
communication between the receptacle tip 408 and the connector
portion ring 414. It will be appreciated that the ring 410 and
connector portion tip 416, as well as the tip 408 and connector
portion ring 414, may be electrically connected by any suitable
means and the present disclosure is in no way limited to the
illustrative schematic. Therefore, for an electrode in electrical
communication with the receptacle 404, the electrode ring acts as
an cathode and the electrode tip acts as an anode. Advantageously,
the adapter 400 may be used where an electrode having a
conventional polarity configuration (i.e., where the tip acts as
the cathode and the ring acts as the anode) initially causes
phrenic nerve stimulation. By reversing the polarity of such an
electrode, phrenic nerve stimulation may be reduced or
eliminated.
[0044] While the present disclosure has been described in
connection with what is considered the most practical and preferred
embodiment, it is understood that this disclosure is not limited to
the disclosed embodiments, but is intended to cover various
arrangements included within the spirit and scope of the broadest
interpretation so as to encompass all such modifications and
equivalent arrangements. For example, and without limitation, while
the illustrative receptacles disclosed herein are generally shown
as bipolar, it will be appreciated that the receptacles may be
configured to receive any suitable multipolar electrode, and
include various permutations of parallel connections between
receptacles, and remain within the scope of the present disclosure.
Further, it will be appreciated that parallel connections among the
receptacles may be arranged among any suitable number of
receptacles. Moreover, and without limitation, while the
illustrative connector portions disclosed herein are generally
shown as bipolar, it will be appreciated that the connector
portions may be configured as multipolar and remain within the
scope of the present disclosure.
* * * * *